The COVID-19 pandemic is growing in intensity across much of the world. The recent surge of cases has dashed hopes that summer weather would prove inhospitable for transmission. Indeed, the world saw the highest number of reported daily cases on Saturday, July 11, with Our World in Data reporting 230,051 new cases in a single day.
Many countries have mounted inadequate responses that are failing to contain the spread. On Monday, July 13, Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization (WHO), criticized governments for “head[ing] in the wrong direction,” noting that, “The virus remains public enemy number one, but the actions of many governments and people do not reflect this.”
Against this background, it has become even more clear that the virus is having a disproportionate effect on certain groups – both in terms of rates of infection and recovery. For example, new epidemiological data from the U.S. show stark racial and ethnic disparities in care and survival outcomes: African-Americans and Latinos are three times as likely to become infected and twice as likely to die from the virus as white people. In addition to race and ethnicity, other factors, like type of employment and age, are affecting outcomes related to COVID-19.
This week’s edition of Rabin Martin’s COVID-19 Briefing explores the intersection of the pandemic and population dynamics. For a virus that, in theory, does not discriminate, why are so many specific groups falling ill and dying? What can we do to achieve and sustain a more equitable response? Please find our earlier COVID-19 Briefings here.
There have been 3,536,658 confirmed cases and 137,897 deaths in the U.S.
COVID-19: Who is at Risk?
Racial disparities continue to grow in the U.S.
Since COVID-19 began spreading in the U.S., inequities have been evident. Disparities have been so glaring that the U.S. government recently changed its policy on reporting race and ethnicity to understand better the disproportionate burden of COVID-19 on communities of color. For instance, in Illinois, where Latinos already have the highest infection rate in the state, many were counted erroneously as “non-Hispanic white,” leading to significant underestimates of the virus’ burden in Latino communities.
People of color are more likely to be employed in professions that do not allow for remote work or proper social distancing. From the janitorial staff maintaining sanitation at hospitals, to the grocery store clerks stocking shelves, to the public transit engineers driving buses and trains, workers in these jobs have significantly greater risk of infection. In Philadelphia, Black and Latina pregnant women are five times more likely to have been exposed to COVID-19 than white pregnant women.
Beyond experiencing higher rates of infection, Black and Latino Americans have faced elevated rates of morbidity and mortality from COVID-19. While higher rates of comorbidities, such as diabetes and hypertension, put these communities at greater risk of severe COVID-19, that fact alone doesn’t explain the disparities. According to a study published this week that examines racial/ethnic disparities in COVID-19 cases, dimensions such as employment and household composition might contribute to differences in rates of infection. The article noted that an area of further research is the “psycho-social stressors that minorities can face due to racism and discrimination.” Camara Phyllis Jones, recent past-president of the American Public Health Association, put it more bluntly: “What we’re seeing here is the direct result of racism.”
Frontline health workers and direct risks
Grappling with limited or nonexistent personal protective equipment, healthcare workers around the world have had to contend with direct risk of infection as they care for patients with COVID-19. In Kenya, where the virus is far from hitting its peak, 450 health workers have already been infected. In Mexico, that figure has reached 8,544, but pales in comparison to Brazil, which has reported nearly 10 times the number of infected healthcare workers at 83,118. At the same time, incidents of suicide have been reported among frontline workers dealing with the pandemic.
Certain countries have implemented salary increases for their health workforce, acknowledging their indispensable role in caring for patients with COVID-19. In France, health workers organized large scale protests which succeeded in securing $9 billion in pay raises. “This is, first of all, recognition of those who have been on the front line in the fight against this epidemic,” said the French Prime Minister, Jean Castex.
On Monday, July 13, Amnesty International published a report, “Exposed, Silenced, Attacked: Failures To Protect Health And Essential Workers During The Covid-19 Pandemic,” documenting the experiences of health workers around the world. According to the report, over 3,000 healthcare workers have died as a result of COVID-19 – a number referred to as a “significant underestimate.” The report notes that Russia is the country with the most deaths among health workers (545), followed by the U.K. (540), U.S. (507), Brazil (351), and Mexico (248). “Governments must be held accountable for the deaths of health and essential workers who they have failed to protect from COVID-19,” Amnesty International argued.
Children and the many unknowns
Children, although at a lower risk for infection and severe COVID-19, are a population of increasing concern. Our understanding of COVID-19’s pediatric impacts continues to evolve as more science comes to light. A French study published on Tuesday, July 14, reports that a newborn was infected with COVID-19 in the womb. This may be the first confirmed case of the virus passing from a pregnant woman to an unborn child.
Complications and deaths related to COVID-19 remain rare among children, with most experiencing mild symptoms or remaining asymptomatic. However, recent studies suggest a rise in potential inflammatory conditions, specifically multisystem inflammatory syndrome in children (MIS-C), which can lead to life-threatening problems. Children who have been exposed to COVID-19 and developed antibodies are more likely to develop MIS-C. This finding has sparked concerns around pediatric vaccines, since the immune response triggered by a vaccine could also increase risk for MIS-C. At this stage, it is too early in the life of the virus to predict COVID-19’s long-term effects on children.
The scientific community’s growing understanding of COVID-19 in children will have a major impact on decisionmakers’ plans for reopening schools in the fall. The most recent data highlight that children represent a small proportion of infection rates globally. However, the number of confirmed pediatric cases is expected to increase in the coming weeks due to a rise in testing. For example, in Florida, almost one-third of children tested were confirmed positive for infection following an uptick in testing. Testing has increased for children as day care centers, summer camps, and recreational settings use results to gauge risk and decide whom to admit.
COVID-19 Global Cases (Center for Systems Science and Engineering at Johns Hopkins University)
On Monday, July 13, WHO cautioned that the crisis is reaching an inflection point. Countries must take more vigorous action to contain the spread or cases and deaths will grow exponentially. “If populations do not follow the basic public health principles… there is only one way this pandemic is going to go. It’s going to get worse and worse and worse,” said Dr. Tedros.
He offered this dire warning after the world reported one million new cases in a five-day period. Cases in Africa have passed half a million, likely an underestimate, and Europe has exceeded 2.6 million cases. The epicenter of the pandemic remains in the Americas. On Sunday, July 12, ten countries accounted for almost 80 percent of reported new cases, and just two – the U.S. and Brazil – were responsible for about 50 percent.
In the U.S., many states that reopened early are experiencing severe strains on their health systems from the unexpected rise in hospitalizations due to COVID-19. Over the past two weeks, cases have increased in 41 states, with many breaking earlier records for highest number of daily deaths. 22 states are rolling back or pausing their reopening plans, though stopping short of returning to the full lockdowns that damaged the economy in late March and April. Dr. Robert Redfield, Director of the U.S. Centers for Disease Control and Prevention, expressed cautious optimism on Tuesday, July 14, when he stated: “If we could get everybody to wear a mask right now, I really think in the next four, six, eight weeks, we could bring this epidemic under control.”
Brazil’s president Jair Bolsonaro continues to dismiss the gravity of the pandemic, even as he tested positive for COVID-19 last week. Bolsonaro has been relentless in imposing pressure on mayors and governors to lift social distancing requirements and reopen businesses to avoid economic crisis. These risky actions amid a spike in infections have led to almost two million cases of COVID-19 across the country.
Kenneth Frazier, Chairman and CEO, Merck & Co.
Vaccine development is progressing rapidly, but major questions remain. What level of immune response and antibodies is needed to provide protective immunity? How long will that immunity last?
As companies forge ahead to Phase 3 trials and attempt to answer those questions, the U.S. government is pushing companies to begin producing vaccine candidates at risk, even before regulatory approval, so that supplies will be ready for immediate distribution once the vaccines are shown to be safe and effective. A senior U.S. official said on Monday, July 13, that at least one company receiving federal funding for a COVID-19 vaccine candidate is on track to begin manufacturing “by the end of summer” while researchers await trial data to determine the vaccine’s efficacy.
From the Experts
“The success countries are having with COVID-19 has relied completely on the success that we’ve built in HIV.”
Ambassador Deborah Birx, Coordinator, White House Coronavirus Task Force
Friday, July 10
“If we just let drugs and vaccines go to the highest bidder, instead of to the people and the places where they are most needed, we’ll have a longer, more unjust, deadlier pandemic.”
Bill Gates, Co-founder, Bill & Melinda Gates Foundation
Saturday, July 11
“Scientists need to stand together in defense of science but most importantly in the defense of people’s lives.”
Dr. Keith Martin, Executive Director, Consortium of Universities for Global Health
Monday, July 13
“We did not shut down entirely, and that’s the reason why [the number of cases] went up, started to come down, and we plateaued at a level that was really quite high.”
Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Disease
Monday, July 13
“No country should do this alone—especially since we improve our chances of success and reduce competition if we work together.”
Dr. Carissa Etienne, Director, Pan American Health Organization
Tuesday, July 14
“No one wants to go backwards but the reality is our fight against the virus is not over and we must have a plan at the ready to protect our current position if it comes back.”
Jacinda Arden, Prime Minister, New Zealand
Wednesday, July 15
Reports from International Governments and Bodies
- WHO COVID-19 Information and Guidance
- WHO Situation Reports, July 13, July 14, July 15
- CDC Coronavirus Resource Page
- COVID-19 Health Systems Response Monitor
- NCD Alliance COVID resources relevant to NCDs
Funding and Policy Trackers
- International Monetary Fund Policy Tracker
- Kaiser Family Foundation Coronavirus Policy Tracker
- U.S. Chamber of Commerce Foundation
Resource Pages and Market Research Literature
- JAMA Resource Center
- The Lancet COVID-19 Resource Centre
- 2019 Novel Coronavirus Research Compendium (NCRC)
- National Academy of Medicine COVID-19 News and Resources
- WIPO COVID-19 IP Policy Tracker
- The COVID Tracking Project
- PharmaIntelligence: Coronavirus – What will the Impact Be?
- Health Affairs Resource Center
- STAT News COVID-19 Tracker
- Global Health NOW’s COVID-19 Expert Reality Check
- International Association of National Public Health Institutes COVID-19 Resources
- Primary Health Care Performance Initiative Forum
- U.S. Global Leadership Coalition COVID-19 Issue Briefs
- Prevent Epidemics Weekly Science Review
What We’re Reading
- We Ran The CDC. No President Ever Politicized Its Science the Way Trump Has – Tom Frieden, Jeffrey Koplan, David Satcher and Richard Besser, The Washington Post
- If You Want to Save the Economy, Stop the Pandemic – Steven Berry and Zack Cooper, Politico
- WHO and UNICEF warn of a decline in vaccinations during COVID-19 – Sabrina Sidhu and Diane Abad-Vergara, World Health Organization
- Why We’re Losing the Battle With COVID-19 – Jeneen Interlandi, The New York Times
- The CDC Has Always Been an Apolitical Island. That’s Left It Defenseless Against Trump – Nicholas Florko, STAT News
- HIV, Tuberculosis, And Malaria: How Can the Impact Of COVID-19 Be Minimized? – Peter Sands, The Lancet
- Time to Make Masks Mandatory? It’s Not Just A US Debate – Angela Charlton And Danica Kirka, Associate Press
- A New Understanding of Herd Immunity – James Hamblin, The Atlantic
- The Pandemic Could Get Much, Much Worse. We Must Act Now – John M. Barry, The New York Times
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About Rabin Martin
Rabin Martin is a global health strategy firm working at the intersection of private sector capabilities and unmet public health needs. Rooted in our mission to improve health for underserved populations, we design strategies, programs and partnerships that both deliver public health impact and drive business results. We leverage our deep knowledge and networks across a wide range of geographies and health areas to develop tailored solutions for every client engagement. We have helped many clients create bold global health initiatives and innovative multi-sector partnerships. Our specific areas of expertise include infectious disease and vaccines, non-communicable diseases, rare diseases, maternal and child health, and universal health coverage. Our clients and partners include multinational health care companies, multilateral institutions, government agencies, large foundations and leading NGOs. Rabin Martin is part of the Omnicom Public Relations Group.
About Omnicom Public Relations Group
Omnicom Public Relations Group is a global collective of three of the top global public relations agencies worldwide and eight specialist agencies in public affairs, marketing to women, fashion, global health strategy and corporate social responsibility. It encompasses more than 6,000 public relations professionals in more than 330 offices worldwide who provide their expertise to companies, government agencies, NGOs and nonprofits across a wide range of industries. Omnicom Public Relations Group delivers for clients through a relentless focus on talent, continuous pursuit of innovation and a culture steeped in collaboration. Omnicom Public Relations Group is part of the DAS Group of Companies, a division of Omnicom Group Inc. that includes more than 200 companies in a wide range of marketing disciplines including advertising, public relations, healthcare, customer relationship management, events, promotional marketing, branding and research.